RESUMEN
Thyroid hemiagenesis is defined as a failure of one thyroid lobe development. This condition predominantly manifests as an incidental finding during radiological investigation. This paper repor ts the case o f a 53-year-ol d female, a known case of hypertension, who visited the ENT clinic at AKU, a ter tiary ca re centre in Karachi, Pak istan and was hospi talized from 12 th to 1 5th Septembe r 202 1. The patient presented with hemiagenesis of the right thyroid lobe with enlargement of the contralateral lobe resulting in airway compression. She was subjected to excision of the thyroid gland without any intra-operative or postoperative com plicati ons. There were n o complaints o f dyspnoea, stridor or hoarseness during the hospital stay. The patient was discharged and was found to be well on subsequent follow-ups.
Asunto(s)
Hipertrofia , Glándula Tiroides , Humanos , Femenino , Persona de Mediana Edad , Glándula Tiroides/anomalías , Glándula Tiroides/diagnóstico por imagen , Tiroidectomía/métodos , Disgenesias Tiroideas/complicaciones , Disgenesias Tiroideas/cirugía , Disgenesias Tiroideas/diagnóstico por imagen , Disgenesias Tiroideas/diagnósticoRESUMEN
Background: Ectopic thyroid gland (ETG) is an uncommon clinical condition, presenting various challenges and limitations in its regulate diagnosis and treatment currently. This study aims to enhance our understanding of ETG and improve the strategies for its diagnosis and treatment. Methods: The retrospective single-center study was conducted, encompassing clinical data from ETG patients screened at our institution between 2013 and 2022. Patients were categorized based on the location of the disease, and follow-ups were performed on each. Results: This study included a total of 47 patients who were confirmed to hav confirmed to have ETG. Among them, we found 29 cases of accessory thyroid and 18 cases of aberrant thyroid. Furthermore, 42 cases exhibited the single ETG, while 5 cases displayed the double ETG. The distribution of the ETG was as follows: 20 were lingual, 10 were submandibular, 10 were lateral cervical, 4 were thoracic mediastinal, 1 was esophageal, and 7 were ovarian. Of these cases, 22 patients underwent surgery, 18 received thyroid hormone replacement therapy, and 7 were placed under observation. All patients were followed up for 59.4 (12-117) months. No significant abnormalities were detected at the conclusion of the follow-up period. Conclusion: ETG is frequently observed in the head and neck, particularly in lingual. Accessory thyroid glands are commonly reported, with most cases being single ETG. Notably, these glands usually do not manifest specific clinical symptoms. Therefore, the appropriate and comprehensive examinations during the initial diagnosis are crucial to avoid misdiagnosis. Treatment should be individualized, and long-term follow-up is essential for managing ETG effectively.
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Disgenesias Tiroideas , Glándula Tiroides , Humanos , Estudios de Seguimiento , Estudios Retrospectivos , Disgenesias Tiroideas/diagnóstico , Disgenesias Tiroideas/cirugía , Resultado del Tratamiento , Glándula Tiroides/diagnóstico por imagen , Laringoscopía , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Ectopic thyroid is a rare condition. Here we report an extremely rare case of parapharyngeal space ectopic thyroid, which has simultaneously found the papillary thyroid carcinoma of the eutopic thyroid. CASE PRESENTATION: A 54-year-old woman was admitted to our hospital for a thyroid tumor and neck lymph nodes. CT and MR imaging revealed the presence of a thyroid right node, as well as a right parapharyngeal mass with a diameter of 2.5 × 2.3 cm. PET-CT was also performed to diagnose further, revealing that the suv metric of the PPS mass was 4.03. Considering that the mass was asymptomatic, we did not handle it at the first thyroid surgery. However, when the patient underwent a radioactive iodine scan before the radioactive iodine treatment, the imaging showed that the mass could intake the iodine. So, we arranged the second surgery for this mass, and the postoperative pathological examination confirmed the mass was well-differentiated thyroid tissue. CONCLUSION: Parapharyngeal ectopic thyroid with eutopic thyroid cancer is extremely rare. Preoperative imaging examination can significantly avoid the missed diagnosis of this disease. Surgical resection is recommended for the ectopic thyroid while the eutopic thyroid is found to be malignant.
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Disgenesias Tiroideas , Neoplasias de la Tiroides , Femenino , Humanos , Persona de Mediana Edad , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Tomografía Computarizada por Tomografía de Emisión de Positrones , Espacio Parafaríngeo/patología , Radioisótopos de Yodo/uso terapéutico , Disgenesias Tiroideas/diagnóstico por imagen , Disgenesias Tiroideas/cirugíaRESUMEN
Ectopic thyroid is well-known pathology for several decades. Many locations have been described. Nowadays, only three cases of skull base location have been described in literature. In our case, we reported a single case of a 39-year-old male presenting with a supra-sellar and suprachiasmatic location. He presented no clinical symptoms, no endocrine alteration on biology and no skull base invasion which make this case unique compared to actual literature. Such diagnosis should always be an exclusion diagnosis as secondary neoplastic should be first ruled out.
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Disgenesias Tiroideas , Masculino , Humanos , Adulto , Disgenesias Tiroideas/diagnóstico , Disgenesias Tiroideas/cirugía , CráneoRESUMEN
Thyroid gland is an endocrine gland playing a major role in energy and phosphocalcic metabolism, among others. It commonly occurs in the anterior cervical and pretracheal region. Ectopic thyroid is quite rare. It is dominated by ectopic basilingual thyroid. We here report the case of a patient with goiter in normal cervical position (eutopic) and ectopic thyroid tissue in basicervical position. Cervicotomy revealed the ectopic nodule and the diagnosis was confirmed by histology. This clinical case illustrates a differential diagnosis of cervical masses.
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Bocio , Disgenesias Tiroideas , Humanos , Cuello , Bocio/diagnóstico , Bocio/cirugía , Disgenesias Tiroideas/diagnóstico , Disgenesias Tiroideas/cirugía , Diagnóstico DiferencialRESUMEN
The lingual ectopic thyroid is a sporadic case. Based on the medical records of Dr. Soetomo General Academic Hospital, Surabaya, they only found one case of ectopic thyroid at least in the last ten years. There is no consensus in the literature about the best therapeutic strategy in managing ectopic thyroid. A 20-year-old female patient with a diagnosis of ectopic lingual thyroid. She has complained of lumps at the base of her tongue since she was ten years old. She performed a partial excision of the tumor with a transoral approach. Partial excision of the lingual ectopic thyroid results in an airway free from obstruction, leaving the rest of the thyroid tissue functioning so that the patient does not require lifelong hormone treatment but has the potential for hypertrophy to recur. The transoral approach provides post-operative results that maintain aesthetic function and reduce morbidity and hospitalization. Partial excision of lingual ectopic thyroid gives good results.
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Tiroides Lingual , Disgenesias Tiroideas , Humanos , Femenino , Adulto Joven , Adulto , Niño , Tiroides Lingual/diagnóstico , Tiroides Lingual/cirugía , Lengua/cirugía , Disgenesias Tiroideas/diagnóstico , Disgenesias Tiroideas/cirugía , Tiroidectomía/métodosRESUMEN
Introduction: Ectopic thyroid tissue (ETT) is a rare cause of mediastinal masses, representing less than 1% of all mediastinal tumors (1). ETT could be detected anywhere along the path of the first embryonic descent of the thyroid gland from the primordial foregut floor to its usual pre-tracheal position. ETT mediastinal localization accounts for fewer than 1% of all ectopic thyroid cases (2,3). Various surgical methods for approaching mediastinal masses have been documented in the literature, including median sternotomy, posterolateral thoracotomy, and, video-assisted thoracoscopic surgery (VATS) (4). More recently, robotic-assisted thoracoscopic surgery (RATS) has been proposed for these masses. The aim of this article is to present the use of robotic-assisted thoracoscopic surgery (RATS) for a rare case of a mediastinal ETT. Case presentation: We present the case of a 40-year-old male with no significant medical history who discovered a mediastinal mass on a thoracic CT scan following COVID-19 infection. Symptoms were dysphagia and anterior thoracic pain with cervical extension. Scintigraphy confirmed the presence of ectopic thyroid tissue in the mediastinum as well as a normal cervical thyroid gland. ETT was histologically confirmed by endoscopic ultrasound guided biopsy. Robotic assisted surgery was the chosen approach to surgically treat this mass and the technical details are presented. The mass was extracted through the cervical incision. Total surgical time was 230 minutes, and the blood loss was 60 ml. The patient was discharged after 48 hours with follow up showing a full recovery with no residual pain or respiratory symptoms. Conclusion: Ectopic thyroid tissue (ETT) is a rare cause of mediastinal masses, and the diagnosis is always a challenge. Robotic assisted thoracoscopic surgery was proved to be safe and efficient in this rare case of ETT developed in the superior mediastinum.
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COVID-19 , Procedimientos Quirúrgicos Robotizados , Disgenesias Tiroideas , Masculino , Humanos , Mediastino/patología , Resultado del Tratamiento , Disgenesias Tiroideas/diagnóstico por imagen , Disgenesias Tiroideas/cirugíaRESUMEN
Diagnosis of primary hyperparathyroidism (PHP) is based on blood assessments in terms of synchronous high calcium and PTH (parathormone), but further management, particularly parathyroid surgery that provides the disease cure in 95-99% of cases, requires an adequate localisation of the parathyroid tumour/tumours as the originating source, with ultrasound and 99m-Technetium (99m-Tc) sestamibi scintigraphy being the most widely used. We aimed to introduce an adult female case diagnosed with PHP displaying unexpected intra-operatory findings (ectopic thyroid tissue) in relation to concordant pre-operatory imaging modalities (ultrasound + dual-phase 99m-Tc pertechnetate and sestamibi scintigraphy + computed tomography) that indicated bilateral inferior parathyroid tumours. A sudden drop in PTH following the removal of the first tumour was the clue for performing an extemporaneous exam for the second mass that turned out to be non-malignant ectopic thyroid tissue. We overviewed some major aspects starting from this case in point: the potential pitfalls of pre-operatory imaging in PHP; the concordance/discordance of pre-parathyroidectomy localisation modalities; the need of using an additional intra-operatory procedure; and the clues of providing a distinction between pathological parathyroids and thyroid tissue. This was a case of adult PHP, whereas triple localisation methods were used before parathyroidectomy, showing concordant results; however, the second parathyroid adenoma was a false positive image and an ectopic thyroid tissue was confirmed. The pre-operatory index of suspicion was non-existent in this patient. Hybrid imaging modalities are most probably required if both thyroid and parathyroid anomalies are suspected, but, essentially, awareness of the potential pitfalls is mandatory from the endocrine and surgical perspectives. Current gaps in imaging knowledge to guide us in this area are expected to be solved by the significant progress in functional imaging modalities. However, the act of surgery, including the decision of a PTH assay or extemporaneous exam (as seen in our case), represents the key to a successful removal procedure. Moreover, many parathyroid surgeons may currently perform 4-gland exploration routinely, precisely to avoid the shortcomings of preoperative localisation.
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Hiperparatiroidismo , Neoplasias de las Paratiroides , Enfermedades de la Tiroides , Disgenesias Tiroideas , Adulto , Humanos , Femenino , Neoplasias de las Paratiroides/complicaciones , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía/métodos , Pertecnetato de Sodio Tc 99m , Tecnecio , Hiperparatiroidismo/diagnóstico por imagen , Hiperparatiroidismo/cirugía , Sensibilidad y Especificidad , Radiofármacos , Cintigrafía , Tecnecio Tc 99m Sestamibi , Compuestos de Organotecnecio , Disgenesias Tiroideas/cirugíaRESUMEN
An ectopic thyroid is a form of thyroid dysgenesis in which the entire thyroid gland or parts of it may be located in another part of the body than the usual place. The most frequent location is the base of the tongue. Although most cases are asymptomatic, symptoms related to tumor size and its relationship with surrounding tissues, hormonal dysfunction, and seldom malignancy may also occur. Here, we describe the case of an asymptomatic woman who was thyroidectomized 19 years previously for a toxic goiter and treated with conventional L-thyroxine therapy, until we enacted a progressive reduction of dosage of the replacement therapy. Incidentally, because of occasional abdomen discomfort, she was hospitalized in our Division of Endocrinology as there was ultrasound evidence of a large mass in the liver dislocating and imprinting the choledochal duct in the pre-pancreatic site, the gallbladder, and the cystic duct, which could not be dissociated from the contiguous hepatic parenchyma and was in very close proximity to the second duodenal portion and the head of the pancreas. Imaging techniques, such as TC, MR, TC/PET, and 131I scintigraphy, confirmed the large lesion with a diameter on the axial plane of about 8 × 5.5 cm and a cranio-caudal extension of about 6 cm. The impossibility of surgical debulking and/or radiometabolic 131I therapy, in the absence of compression symptoms, led to the multidisciplinary decision of a clinical and instrumental follow-up of this rare lesion.
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Enfermedades de la Tiroides , Disgenesias Tiroideas , Femenino , Humanos , Disgenesias Tiroideas/diagnóstico , Disgenesias Tiroideas/cirugía , Hígado/diagnóstico por imagen , Hígado/cirugíaRESUMEN
In this clinical case, papillary carcinoma was detected in the ectopic area of the thyroid gland in the presence of an unchanged thyroid gland of natural localization. An extremely rare disease is presented and an examination algorithm is proposed that is recommended to exclude unusual pathology in the absence of a response to ongoing conservative treatment.
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Carcinoma Papilar , Disgenesias Tiroideas , Neoplasias de la Tiroides , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/cirugía , Humanos , Tabique Nasal/patología , Disgenesias Tiroideas/diagnóstico , Disgenesias Tiroideas/cirugía , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugíaRESUMEN
ABSTRACT: A 44-year-old female without any systemic diseases had a slowly enlarging anterior neck mass for 1âyear. She had received transcervical surgery for a left thyroid cyst 3âyears ago. An enhanced computed tomography scan showed a hyper-dense, markedly enhancing, and homogenous mass at the level of the thyrohyoid membrane. under the impression of an ectopic thyroid gland, operation was scheduled. However, she worried about cosmesis pitfalls besides the existing scar from her previous thyroid surgery. Transoral vestibular robotic surgery was arranged to prevent an additional neck incision wound. The mass was removed and confirmed as an ectopic thyroid nodule by pathological examination. No recurrence was found at the 1-year follow-up, and the surgical and aesthetic outcomes were satisfied. The surgery can provide adequate surgical exploration with excellent cosmesis, whereas managing cervical masses. For the cosmetic concerns, this procedure is the potential alternative in other neck surgeries.
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Procedimientos Quirúrgicos Robotizados , Disgenesias Tiroideas , Neoplasias de la Tiroides , Adulto , Estética Dental , Femenino , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Disgenesias Tiroideas/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodosRESUMEN
Benign ectopic thyroid tissue within the parotid gland is very rare with only one case reported till date in the world literature. We report a case of ectopic thyroid in the left parotid gland with an orthotopic thyroid in an elderly female, who was presented to us with the simultaneous onset of right-sided thyroid swelling and left parotid swelling for 6 months. Fine-needle aspiration cytology (FNAC) was done from both the swellings and a diagnosis of Hurthle cell neoplasm metastasizing to the left parotid gland was initially made. However, histopathological examination along with the immunohistochemistry (IHC) panel proved it to be an ectopic thyroid in the parotid. The case is being documented here for its rarity as well as an unusual presentation so that the readers are aware of this entity and the complete workup required to prevent diagnostic pitfalls.
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Glándula Parótida/patología , Disgenesias Tiroideas/patología , Disgenesias Tiroideas/cirugía , Glándula Tiroides/patología , Adenoma Oxifílico/diagnóstico , Adenoma Oxifílico/patología , Anciano , Biomarcadores de Tumor/análisis , Biopsia con Aguja Fina , Antígeno CD56/análisis , Citodiagnóstico , Proteínas de Unión al ADN/análisis , Femenino , Humanos , Tiroglobulina/análisis , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Factores de Transcripción/análisisRESUMEN
Ectopic thyroid tissue in the lateral neck is a rare finding, especially in the submandibular region. This case report presents a 38-year-old female patient with swelling in the lateral cervical neck. Due to a thyroid goitre, right hemithyroidectomy was performed in the past. However, a persistent high thyroglobulin level was detected after surgery. Regarding the suspected tumour in the submental region, a cervical magnetic resonance imaging (MRI) was performed, which revealed a suspicious looking mass. The patient underwent complete surgical excision and the histopathological report concluded that the tumour was ectopic thyroid tissue. Her thyroglobulin level decreased back to a normal level after excision of the submandibular mass. These results show that ectopic thyroid tissue must be considered a differential diagnosis for patients with unclear swelling in the submental region.
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Glándula Submandibular/diagnóstico por imagen , Tiroglobulina/sangre , Disgenesias Tiroideas/diagnóstico , Adulto , Diagnóstico Diferencial , Femenino , Bocio/cirugía , Humanos , Imagen por Resonancia Magnética , Glándula Submandibular/patología , Disgenesias Tiroideas/cirugía , Tiroidectomía/métodosRESUMEN
Thyroglossal duct cyst is the most common cause of anterior midline neck swelling in children, but ectopic thyroid is an important but rare differential diagnosis. Establishing the orthotopic thyroid gland status is crucial as inadvertent removal of a lone functioning ectopic thyroid tissue in young children could lead to fluttering of growth and development if not identified early. We report the case of a 2 years 10-month-old boy who had Sistrunk's procedure for 'thyroglossal duct cyst': Diagnosed using USS, defaulted follow-up and presented subsequently with growth retardation from hypothyroidism.
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Hipotiroidismo , Quiste Tirogloso , Disgenesias Tiroideas , Niño , Preescolar , Diagnóstico Diferencial , Humanos , Hipotiroidismo/diagnóstico , Hipotiroidismo/etiología , Lactante , Masculino , Quiste Tirogloso/cirugía , Disgenesias Tiroideas/diagnóstico por imagen , Disgenesias Tiroideas/cirugíaRESUMEN
BACKGROUND: Ectopic thyroid papillary carcinoma presenting as bilateral neck lymph nodes metastasis is very rare. Ectopic thyroid tissue may appear in any location along the trajectory of the thyroglossal duct from the foramen cecum to the mediastinum. It is subject to malignant transformation and is classically accompanied by a similar transformation of the native thyroid gland. Similar to that of the native thyroid gland, the most common malignancy found is Papillary thyroid carcinoma. Unusual cases in which ectopic thyroid carcinoma presents with normal native tissue support an alternative hypothesis that ectopic thyroid tissue may develop malignancies independently from the native thyroid gland. OBJECTIVE: We present an extremely rare case of a 30-year-old woman previously diagnosed with Hashimoto's thyroiditis, presenting with a palpable mass in the lateral neck suspicious for malignancy. RESULTS: After several examinations and surgical removal of the mass, histopathologic evaluation of the continuous sections of the thyroid, demonstrated metastatic disease from papillary carcinoma of the thyroid. Total thyroidectomy and biopsy revealed benign thyroid tissue without any foci of microcarcinoma. A hypothesis of ectopic thyroid tissue and its malignant transformation was made. CONCLUSION: By presenting this case, our goal is to highlight and make the physicians aware of the possibility of developing primary carcinoma of the ectopic thyroid tissue, without an active tumor of the thyroid gland.
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Carcinoma Papilar/complicaciones , Carcinoma Papilar/fisiopatología , Carcinoma Papilar/cirugía , Metástasis de la Neoplasia/fisiopatología , Cáncer Papilar Tiroideo/fisiopatología , Cáncer Papilar Tiroideo/cirugía , Disgenesias Tiroideas/fisiopatología , Adulto , Femenino , Humanos , Disgenesias Tiroideas/cirugía , Resultado del TratamientoRESUMEN
We report a case of a 46-year-old woman who presented with a midline neck mass 2 years after total thyroidectomy for Graves' disease. Despite levothyroxine treatment withdrawal, she remained biochemically with subclinical hyperthyroidism. Her thyroid stimulating hormone receptor antibodies were consistently elevated. Neck ultrasonography revealed an infrahyoid solid nodule and pertechnetate scintigraphy confirmed an increased uptake at the same level, without any uptake in the thyroid bed. Treatment with methimazole 5 mg/day was initiated with clinical improvement and achievement of euthyroidism. After that, she received 10 mCi of radioactive iodine. Since then, she experienced regression of the neck mass and is doing well on a replacement dose of levothyroxine. Recurrence of Graves' disease in ectopic thyroid following total thyroidectomy is extremely rare. This diagnose should be considered in patients who underwent total thyroidectomy and remained with thyrotoxicosis despite decreasing the levothyroxine dose.
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Enfermedad de Graves , Disgenesias Tiroideas , Neoplasias de la Tiroides , Femenino , Enfermedad de Graves/cirugía , Humanos , Radioisótopos de Yodo , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Disgenesias Tiroideas/diagnóstico por imagen , Disgenesias Tiroideas/cirugía , TiroidectomíaRESUMEN
Lateral aberrant ectopic thyroid is very rare, comprising only 1%-3% of all the ectopic thyroid tissue. Clinically, these lesions are mistaken for lymph node swelling or metastatic tumour. Primary carcinoma in lateral aberrant ectopic thyroid with normal active native thyroid is very uncommon. We report a case of papillary carcinoma in lateral aberrant ectopic thyroid tissue, with a completely normal native thyroid gland in a 53-year-old man, who presented with a massive swelling in the lateral aspect of the neck clinically and radiologically diagnosed as a malignant soft tissue tumour with differential diagnosis of malignant lymphoma. Fine needle aspiration cytology revealed metastatic papillary carcinoma. In toto excision of the soft tissue mass along with subtotal thyroidectomy was performed. Histology of the mass revealed papillary carcinoma of lateral aberrant ectopic thyroid, while the thyroid gland did not show evidence of malignancy. The postsurgical period was uneventful, and the patient underwent radioiodine ablation.